Supplementary Material for: Coronary Computed Tomography Angiography in Diagnosing Obstructive Coronary Artery Disease in Patients with Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

<b><i>Introduction:</i></b> Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown. <b><i>Methods:</i></b> We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated. <b><i>Results:</i></b> We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87–0.99) and 0.66 (0.57–0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74–1.00) and 0.67 (0.49–0.82), respectively. <b><i>Conclusions:</i></b> Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.

<b><i>引言：</i></b> 冠状动脉计算机断层血管造影（Coronary computed tomography angiography, CCTA）正逐步成为冠状动脉造影领域重要的非侵入性检测手段。目前针对晚期肾病患者群体中CCTA的应用性能特征尚未明确。
<b><i>方法：</i></b> 本研究针对以冠状动脉造影作为参考标准、探究晚期肾病患者（定义为依赖透析或即将接受肾移植）中CCTA的灵敏度与特异度的相关研究，开展系统综述与荟萃分析。由两名独立研究者对研究的纳入/排除标准、研究质量及特征进行评估，并由第三名研究者进行最终裁定。
<b><i>结果：</i></b> 最终纳入4项研究，共计217名患者，其中159名依赖透析。4项研究中，3项在患者选择与研究流程方面存在较高偏倚风险，仅1项在所有偏倚维度上均为低风险。各研究在患者选择与CCTA扫描方案上存在异质性，但对阻塞性冠状动脉疾病的定义保持一致。CCTA的合并灵敏度与特异度分别为0.96（0.87~0.99）与0.66（0.57~0.74）。当将分析范围限定为依赖透析的患者时，CCTA的合并灵敏度与特异度分别为0.99（0.74~1.00）与0.67（0.49~0.82）。
<b><i>结论：</i></b> 基于有限的研究数据，相较于非肾病患者群体，CCTA在晚期肾病患者中展现出相当的灵敏度，但特异度更低。